Training Date: February 3, 2021
Julian Cancino: Hello. Welcome to our family building training series. Today we're being joined by our friends at Fenway Health. I am Julian Cancino, Director of the Gender and Sexuality Center and this session is part of our Lunch and Learn Ally Training series, which offers affirming and welcoming information to faculty and staff on building inclusive classrooms and Campus Community. I'm super excited to be in collaboration with Elly and Salem. Fenway Health as many of you already know, Fenway Health is an international pioneer in helping LGBTQ people become parents and it is my my sincere hope that today's resources and information will support you in your path to parenthood. I would like to now introduce Elly and Salem. Elly Humphrey is the behavioral health specialist at Fenway Health. Elly uses she and her pronouns. And Salem Kats Quinn, is the alternative insemination program coordinator also Fenway Health and Salem uses they/them/their's pronouns and so without much further ado, please take it away.
Elly: Right, thank you so much for that introduction! I am Elly and I'm the behavioral health specialist at Fenway, which is essentially a fancy way of saying that I'm a therapist um... So I am going to be talking, today, mostly from the perspective of mental health related things and then Salem we'll talk a little bit more specifically about the AI side of it. So I am going to talk a little bit about LGBTQ family building and in this presentation I'm going to be using the word queer as a shorthand for LGBTQ majority of folks are pretty comfortable with that term not necessarily everybody identifies with it, but for today I'm just going to use it as a shorthand. So there are a number of different aspects of mental health, which come into play when it comes to building families, regardless of identity, but especially when it comes to building families that could be considered alternative or for queer folks and a number of different ways, so one thing, just to kind of acknowledge right off the bat is that there is no really concrete straightforward path to building a queer family and that those are going to look really, really different depending on who you are and what makes the most sense for you. And one of the more powerful and exciting things about building a queer family is that you kind of get to choose to choose your own adventure about what is the best fit for you what you want your life to look like what you want your family and your community to look like. So that can be anything from choosing what you want your immediate community to look like who do you want to live with, who do you want to be in your close knit circle, what do you want your sort of day to day people in your life to look like. And that doesn't even necessarily have to include kids or children in any type of way. And in fact for a lot of queer folks that can be part of the family building process, I think that there's something about being part of the Community where. You may or may not have connections with your own biological family or that might look different from you, depending on how much acceptance, you may or may not have and so friendships or other relationships can become even more important for a lot of folks. For those people who do decide that they are interested in building a family, which includes having children as a part of it, there are a number of different ways that people can choose to go about that, so there is fostering, adopting, having -- and when you are adopting you can decide if you want to go with the state routes or the private routes. When you are fostering or adopting you can make decisions about whether you want to try to have an infant come into your space that is a decision that a lot of people tend to prefer, but then there are also lots and lots of older kids or even teenagers, who are up for fostering and adopting and one of the cool things about building your own family, as you can kind of decide like are you really hoping to go through the entire parenting journey from infant hood through an older age or are you open to bringing in an older kid or a teenager. Something that is actually really, really significant is that there are a lot of clear LGBTQ identified teenagers in the adoption and foster care systems, who maybe have a harder time finding families who are affirming, are supportive, and so for folks who are interested in that -- that can be a really, really powerful way to make an addition to your family. There is also (inaudible) and we'll get into in much more detail, AI is an option, surrogacy, and then also a lot of queer folks can have their own biological children by the sort of more traditional or straightforward means. There can be a lot of unique challenges which come along with building a queer family. For one, there is the aspect of just... it is less often a kind of straightforward or culturally sanctioned process for a lot of people. Whereas cis gender, heterosexual people kind of have a cultural script/ direct expectation of what your family building might look like and it's very normalized. For queer folks that is going to look different a lot of the time, and so just making active choices about what you want your family to look like, it's going to be a unique experience for every individual, I can make sort of generalizations about what that might look like, or what that might feel like for some particular people but as a therapist I will just generally say that there is no way to kind of make a blanket statements about what any particular person's emotional experience might be of anything. And when in doubt, it's always best to be curious and ask them -- I'm not sure but some of the common challenges that I have talked a lot with clients about include things like finding acceptance from your community in parenting relation to your gender your sexuality. For example, one of the services that we offer at Fenway which I would love to plug a little bit here is that we offer a support group for Trans, non-binary, gender non-conforming folks who are either parents or prospective parents that group is free and open to the public I'm happy to offer the details of that little bit more later. But I hear a lot of themes come up in this group, which are you know, particularly challenging from a mental health standpoint, for a lot of people. One of the things that I hear come up a lot is finding sort of support or community around the experience of parenting. One example of that is I have somebody in my group, right now, who frequently attends who is non binary. This person lives in a rural area of Massachusetts, has two kids, and is really interested in finding community with other parents to kind of just talk about what those experiences are like and get involved in the kids school. And their rural town has a dad's group and a mom's group. They initially went to the this person as assigned female at birth; wasn't really sure how that would be received in either of these groups, decided to go to the moms group thinking that that might be a little bit more of an open space, got some implicit understanding that they were not extremely welcome in that space, decided to go check out the dads group and see how that would fare for them and we're explicitly told that they were not welcome in the dads group. Um so that's just one example of how a parent just trying to exist in the world and be authentic to who they are can struggle to find community with other folks who are going through similar challenges. Something else that comes up a lot for folks, especially with trans parenting is navigating how to kind of weigh out some really complicated decisions around pursuing gender affirming medical care versus becoming a parent. Obviously, there are a lot of types of gender affirming medical care, whether it be hormone treatment or a variety of different types of surgeries which can impact fertility, some of them more so than others, and that can be a really significant challenge for a lot of people to sort of navigate the decision making around these priorities. You know, there may be folks who say it's really, really important to me to have biological children that's something that's I've always wanted as a part of my life, but also You know, pursuing x y z medical treatment is also really, really important to my gender identity, my comfort in my gender expression, my comfort in my own body... And I know that pursuing this medical treatment is going to impact my fertility impact my ability to have biological children. So those can be really, really challenging decisions for people to make especially a lot of the time for younger folks who may say: I know that I want to do this, several years down the road but I'm not planning on starting a family for 10 years. And there are definitely ways to preserve fertility or to store gametes and to be able to have biological children down the road, but then there are also other complicating factors. For example, I have another person who regularly comes to our trans parenting support group who Is non-binary identified, is really interesting and interested in having top surgery at one point but also came from a background where their family's very, very into everything sort of be natural and organic and this is just a really part of big part of their upbringing and their cultural context and their family has really ingrained into them that the only, the only real way to nurture an infant is to breastfeed that infant and so this person is trying to navigate like-- okay, how long do I put off having surgery? If I eventually would like to breastfeed my infants and there are just a number of different complicated or challenging decisions that can be made along the way, and there really is no right or wrong decision that's going to be a blanket answer for every single person. So one of the things that I really like to encourage is getting support from your community. I'm getting. The opportunity to process that with people and then, if you know somebody who's going through that decision making process, just sort of being open to hearing them out and being with them through that and knowing that there is not really often a clear cut and right answer. Another thing that some folks might run into this is a more specific thing that got submitted ahead of time is, for example-- if there is a lesbian couple who is going through the process of AI and one of the partners is pregnant and the other one is not the one who is carrying the child, that can be a complicated dynamic between the two parents. Again, and that comes into play, where we have sort of a cultural script around what it means to be a mom. And there's a lot of idea around you know, a mom -- as somebody who carries a child, who is pregnant, who goes through certain processes. You have a. physical experience, you have a social experience of that, and there can be some significant challenges that come up if you are you know very much invested in being that child's mom but you aren't having those same experiences that somebody else might be expecting from you or that you may have envisioned yourself having and in this particular situation. Similarly, I think that there's no concrete way that we can say every single person in this dynamic might feel it might be that some moms in the situation might feel a sense of grief or loss or really missing out on an important part of the dynamic and in that case, it may be helpful to say we're really going to listen to your experience empathize with it validated try to include you in as many rituals, as we can make sure you're having that baby shower, that parental leave. Having plenty of time to bond with that infant when they're born and just really trying to get you in on that process as much as possible. But I think equally important is to not making assumptions that is necessarily something that somebody would want or would be important to them. Because, as we know, in queer couples, the types of roles that people take on and relationships or parenting can be nuanced and they can be different and we don't always know what is or isn't best for somebody so it may be, the fact that the non-carrying parents in that dynamic says: I have never wanted to be pregnant, this is not something that interests me, this is not something I'm comfortable with, and it may actually make them uncomfortable if you're saying... If you're implying that they're really missing out on something or, of course, they would have wanted to carry that child because maybe that has nothing to do with their identity or their preferences. I think that, overall, what is most important is to just recognize that the process of queer parenting and queer family building is so so nuanced and it's going to look different for every couple or every individual or every family, and that is one of the most challenging things about queer family building, but it can also be one of the most beautiful and most exciting things about queer family building, because you can be empowered to make those choices for yourself and be really conscious and deliberate about what you want your family to look like and that can be a powerful thing. So just sort of wrapping all of that up a little bit, Fenway Health does have a variety of mental health services which are available for folks. The majority of the time, the way that it works is, if you are looking for individual therapy or for a lot of our groups we do look to have you be a medical patient for primary care with us. But one of the exceptions are ways around to this is, if you are trans, in which case you are able to access our therapy services without having to be a primary care patient. For anybody who's interested in that you can get set up with those services by pretty much just calling our main number and asking about it that's 617-927-6000 that's pretty easily Google-able too. And then there are also a number of free, open to the public support groups where you don't even have to really engage with that system at large and just to kind of circle back and plug the group that I do run again if anybody is interested, or if this is something that you'd like to pass along to friends or family or anybody else. It is the last Wednesday of every month, it can it is free and open to the public, it is accessible by zoom and maybe if this works, I could pass this along to Julian. I don't know if you would be willing, if I gave you the information for that, if you could pass it along? Okay, perfect. So I think that that covers some of the broad strokes of the mental health side of this, I know that I just sort of grazed over a bunch of topics very, very quickly, I could probably give an entire hour long talk on several of these sub subjects, but. that is the the introduction to things and I encourage you, if any of these things are interesting to you, there are tons and tons of great resources out there I'd be happy to point you in the right direction if you want to learn more and if any of these things are deeply personal to you. Consider joining a group or coming to therapy, we'd love to have you. But now to kind of dig a little bit more into the API side of things, we have Salem who is our AI coordinator and can talk a little bit more about that.
Salem Quinn: Thanks so much Elly! It's yeah... I'm so glad we were able to start off with that portion of it because growing a family becoming a parent expanding a family, however, that looks always you need support it really does take a village. And especially for the LGBTQIA plus, which I will also refer to in short as the queer Community. It makes it a little extra challenging but still possible, and definitely lot more accessible now than it used to be. So I'm the coordinator for the alternative insemination program at Fenway Health; our mission is to be a local and national resource for queer couples and single people who want to have children through donor insemination. The little bit of history, you know it used to be that a single person or a person whose spouse didn't have sperm, if they wanted to grow a family, they had to go to a reproductive endocrinologist at a fertility center. Costs usually we're not covered by insurances and those costs are very, very expensive. Back in 1983 when our program was started, we were you know single people and couples who you know, one of the people didn't have sperm. They were denied access to local sperm banks and so Fenway Health started our program alternative insemination, the medical term is artificial insemination - it's the same thing. It started, so we could find some loopholes, start getting sperm from banks that were out of state, and it started off with teaching people the process. And they were doing home insemination as you may commonly know it as the Turkey baser method. And eventually about 10 years later, we started doing office in seven nations, which means that it was a little bit more advanced than the Turkey baser method. And then recently, back in 2018 Blue Cross Blue Shield of Massachusetts only started covering the cost of these and inseminations, what we commonly referred to as social infertility meaning. You're a single person, so you need either some sperm or an egg or you're in a couple where no one has sperm or no one has an egg and you need to look for a donor. Our program specifically works with people who are under the age of 44 and are looking to do insemination with donor sperm. We do have plenty of resources for people who wouldn't quite fit into our program and we can point them in those directions, but the majority of what I'm going to be talking about for my time is specifically people who are single people or in a couple where you know, no one has sperm. They're like Elly was saying, there are so so so so so many ways to grow a family and even with doing alternative insemination, you have a few options are you going to use an anonymous donor from a bank, you could use a known donor friend or your partner's relatives. And then there's a number of different types of insemination, that you could do you could do it in the office you could do it at home, you can use a fresh specimen you can use a frozen specimen. So yeah there's a variety of ways to get this done and I'm going to talk a little bit about that. In general, our program is-- I know it's really it's really doing well. Since 1984 we've had over 1000 pregnancies and going on 800 births. We...the reason why we have a limit of you know, serving people who are under 44 is because, after the age of 40. people's fertility tends to start to decline, and so, once it gets to 44 it it really just didn't feel right taking these people's money because the chances were so so slim to get pregnant. And so it was like if you're over the age of 44 you know pregnancy is still possible, but you need a higher level of care. We have people who are using their natural cycles and we go through a process of teaching people how to track their cycles and how to kind of figure out when their ovulation is happening, so that they can figure out what is the best time frame to do these insemination. Now for people who are using a fresh specimen whether it's a known donor, or whether they're in a cis-hetero relationship, that sperm once it's in the body, can live you know up to five days, so you have a little bit wider window for getting that ovulation and inseminations time. If you're using a frozen donor, which is commonly what people are in our program use. Once that specimen is in the body you got 24 hours, so we really need to get the timing down right and that's the majority of what our program does is teaching people about tracking their cycles about what they can do to predict ovulation and how to figure out timing. Those inseminations, majority of people use frozen donors from a bank, so it's an anonymous donor and then they will come into the office and do office inseminations. The reason for this is if they need a higher level of care, if they need to go to a reproductive endocrinologist, maybe get IVF, the insurance needs to prove that the person who wants to carry has been exposed to sperm for six cycles and we can provide that documentation. We tried six times, person's not pregnant... cover their IVF. In Massachusetts it is mandated that insurances need to cover fertility services. However, to make you jump through a few hoops unless you're a cis-hetero relationship, in which case you can just show up be like we've been trying for a year we're not pregnant and then they get covered. When someone is doing home inseminations, insurances don't typically count that because there's no document, but I have known some people who have fought that successfully. So for our program, we're doing inseminations, we're using a person's natural cycle; it's really pretty basic in terms of level of care. You know our providers are trained on how to do these inseminations on how to troubleshoot and whatnot. But we're not doing any surgery, this is a very basic procedure, it takes about 10 minutes and it's...I don't know it's like getting a pap it's...it's very minimally invasive. It doesn't -- you know the rates of miscarriages aren't increased or decreased with our methods. They are --yeah your chances of getting pregnant are just as well as any other means. Most people do what we call an IUI -- intrauterine insemination. This uses a specimen that's been washed so washed away of all the plasma, that is not safe for the uterus, and so the provider can deposit the specimen inside the uterus kind of give it a running start to go find that egg. Coming from the banks these donors are they really...they're...they're tested, they're quarantined, they do psychological evaluations, they you know... make sure those swimmers are swimming, they do all kinds of things to make sure that what you're getting is a good sample and they charge a lot. The whole process is is very expensive, which is one of the reasons why our program that started; was to make this more cost effective so people didn't have to go to a fertility center. You already need to pay so much for the sperm. We're going to try and keep our costs down to make it more accessible. And of course Fenway health, our priority is to provide care; and if you can't pay, we're going to find a way to get you that care anyway. Whether that's working with our financial assistance program to get your fees reduced or waived entirely or you know, setting up payment plans with our billing department. So intrauterine insemination that's the most common insemination that we do, we also do intra-cervical now that can use sperm that is unwashed; so it's, you know, person donates. It's not treated, it's just frozen, and so it still has all that plasma around it. It can't go in the uterus, but it can be deposited right at the beginning of the cervix. And then doing an insemination at home it's doing perry cervical so you're not quite up at the cervix but it's, you're depositing it pretty much in the vagina. To join our program we have a few steps. First you come to an orientation we hold these orientations every other month. They are about two hours we help them in the evening, and right now, because of COVID, they're on zoom; so they're very accessible to people who are all over. I was just talking with someone from Pennsylvania, who wants to come next month to our orientation, it's pretty much like a one time class. We go into a lot greater detail about what these donors are like what it means to track your cycle kind of what the rates are, for you know pregnancy and these different types of insemination, and a lot more kind of going into the legal issues. Do I need to do a co-parent adoption, can we put both of our names on the birth certificate? It goes into all of that information. Once someone has done that, then we have you know list of labs that needs to be done, you need a recent physical and a pap. And you need to be tracking your cycle for three months with an ovulation predictor kit. This is an over the counter; it's pretty much like a pregnancy test where you're urinating on a stick or urinating in a cup and dipping the stick in. Instead of predicting pregnancy it's predicting your ovulation. Right before a person ovulates, there's a lutonizing hormone that spikes and that's what this test is registering is: Oh, we have that spike that means you're going to ovulate sometime in the next 24 to 48 hours. That's how we have people track their cycles and that's how we have people figure out when they need to do their insemination. Once they have three months of data from tracking their cycles, with an ovulation predictors kit, then we get them enrolled. We do back to back visits, where we go over kind of all the legal sides and social sides of things with the social worker on our team. And then we may meet with our nurse practitioner, the clinical coordinator for our program, go through your full medical history, all the labs you've got done. If everything looks good then you've got the...you can pass go collect $200 - just kidding. You're ready to start insemination. You can order sperm, have them shipped to our facility, we store the sperm there for free, if you're active in the program, and then start setting up appointments. And the way it works is you start your cycle. So you start your period, you know okay, I'm on cycle day one, I know I usually ovulate around cycle day 15, so you reach out and you set up appointments. It's different for everyone. Rights? Everyone's body is different. Everyone's cycle is different. But it's usually like five to 10 appointments, you know. I'm going to set up appointments starting cycle day 13 to cycle day 20. We do insemination every day of the year, you know people's bodies don't pay attention to calendars and so sometimes they ovulate on Christmas Day, on Thanksgiving, whenever. So even if our building is closed, we have providers who are on call to come in and do the insemination, and then the person is testing each month with that population predictor kit twice a day. And then they may call in and leave a voicemail that I check every morning during the week to find out who's ovulating and who's not and then I cancel those appointments if they are not needed. The providers have them available as same day appointments, for you know, because these are providers who do all kinds of care, in addition to being trained on to do these seminars patients. So yeah that's the gist of how our program works. And in terms of medical insurance, it's really tricky. Just today, I got a request from someone who... Their insurance is now going to cover the cost of these insemination, because how it works for most insurances is: oh, if you want to get fertility services, say you need, you know, a little extra care, maby some medications, or ultrasound monitoring that's all done by reproductive endocrinologist. That's something where if you need those covered, you need to either prove medical infertility and a way to prove that is, those six attempts of exposure to sperm I mentioned earlier. However, most insurances don't pay for those six attempts and Blue Cross Blue Shield of Massachusetts realized this inequity, and so they started covering the cost I think people just pay a specialty copay so maybe $30 or $40 instead of the $250. You can get insemination out of fertility center with that higher level of care where they're monitoring the egg with an ultrasound, maybe giving you some medications whatnot, and so that could be maybe thousands of dollars per cycle, in addition to the cost of the sperm. Sperm vials can range from like 500 to over 1000 per vial. One vial is one insemination, and it's very rare that people get pregnant on the first insemination. In general, it usually takes people three to four cycles and yeah the costs are tough to join our program, to attend that orientation, get enrolled it's about $300. That's out of pocket, you can usually use a flexible spending account to pay for it. And then each insemination is $250 and then plus the cost of sperm, which is why some people choose to use a known donor do home insemination, things along that line. It's... It's an expensive process it's also a very intentional process. You know there's no like oops I got pregnant, you're making that decision of: I want to be a parent, I want to do this, and it's a lot, and even the process is is a bit of a roller coaster emotional, which is why we have... we're so interconnected with our support services, why we require that people meet with our social worker to have that enrollment visit to go over identifying. Okay, what do you do when you get stressed out so when you're stressed out you're not going to get pregnant or not very likely. And we have a support group that meets every other week for people who are in our program you know Elly's running the the great trans parenting and prospective parenting group and yeah we tell people, you need to identify your supports and your self care for what you do when things get tough, because this journey is tough. It is...it really is, and I know we had some questions that were submitted beforehand. I know Elly kind of touched on the: What are the options for fertility preservation, while undergoing... under affirming treatment and sometimes that can affect fertility, sometimes not I know it's standard medical practice for an every year, considering it that the provider needs to talk with you about the risks. Some people, you know it's weighing those options of you know, do what's more important for me right now is preserving my ability to have a family or getting this gender affirming care. A lot of times now we're hearing people who are looking into preservation before they even start any affirming treatments. People who are getting their sperm banks and frozen people who are getting their eggs retrieved and you know both of those things are quite a process. In terms of sperm donation, it still needs to be like tested and quarantined. And for egg retrieval it's... it's more of a medical procedure where it's hormones injections, and then they harvest the eggs and then freezing it, and it's all a lot, and it's all very expensive, and I don't know of many or any insurances that cover it. I also know plenty of people who have like I was just talking with someone who's trans masculine and they had been taking testosterone but they stopped and their cycle returned. Which means you know they get a cycle, they their period is happening, they can turn an ovulation predictor kit positive. They can get pregnant, so it's not always an end all be all with that. But it's yeah...it's definitely good to look into the options before you get started. Another question that was asked was I'm a cis gender, Ashkenazi Jewish woman, with a family history of genetic conditions, what are some of my options for reproduction if I want to carry. Plenty there's plenty of options and it's important to talk to your provider about those genetic conditions and about what risks they pose. Your provider can refer you to a genetic counselor if it's needed, and when these donors at the bank are tested-- if that's something you're planning to use, they are tested for everything. So so many genetic conditions and sometimes when you're choosing a donor you're like okay I specifically need someone who doesn't carry this gene. I know, nowadays, a lot of people are doing, like the 23 and me, and things like that. What those are testing is just very unclear on what that all means for fertility and reproduction, and so we think it's very important to talk to an actual genetic counselor. Also, the customer service people at the sperm banks you're paying a lot so they're going to deliver really great care and they're-- they're just wonderful to talk to, and they can. I know a lot of them have genetic counselors on staff that can help help guide you into what would be the best option for you. Another question was what are some reproduction options for cis-gender women over 45? Unfortunately, we do not offer alternative insemination program because, as I stated earlier, with that decrease in fertility after 40, we can only see people who are under the age of 44. After that we, you know, your option is really going to a reproductive endocrinologist. Because it's with a decrease in fertility, you really need a higher level of care. Someone who can do all that monitoring and at that point, so insurance covers it. I think, once you get to a certain age, they will cover reproductive care. What are the factors for choosing a donor, whether it's you're getting an egg donor or a sperm donor? There's there's so many factors... Like I was saying earlier, genetic conditions if that's something that you need to make sure the other half doesn't have. Some people want to choose a donor that has like similar physical features to their partner or similar heritage. It's funny you go on the sperm bank websites and it feels like a dating app, if you're swiping right or left they have baby photos, some of them will have adult photos which I still don't understand how that keeps them anonymous. But what have you... it's not my problem. And you can search by physical features, you can search by you know heritage, you can search by nationality, you can search by so many things. A lot of banks even offer photo matching; you can submit a photo of your partner and say: Okay, I want a donor that looks like that. Some people really want to keep it in the family and that's why a lot of people will use known donors. You know I want to use my my partner's cousin...you know that's that way, I feel connected to the family in that way. So yeah there's there's a lot of different things to consider. And yeah the banks give you plenty of options to search through the donors. What factors should I keep in mind when choosing a fertility program? What's it going to cost, you know each place has different costs. What's the insurance process like, you know, will insurance cover it-- are people going to help you make sure insurance covers it. You know what's the location, we have people that come to our program. You know we're in Boston you know pretty much at Fenway Park, and we have patients coming from Vermont, Rhode Island, New York, Jersey, that person from Pennsylvania, I was just talking to yesterday. We've even known some people to hop on a plane, we have patients who have a child through us and I want to come back for a second child they currently live in Amsterdam. And they're talking about coming in later this year but that can be a little stressful, so some people...so it's good to think about the location and just the logistics of how am I going to get care. Each program has different requirements so if there are certain requirements like... Some places maybe more of a fertility center would require some sort of trans vaginal ultrasound, not everyone's comfortable with that so it's good to know what's going to be expected of you. And I always say it's good to just get the general vibe, you know, you're going to be talking to these people, you're going to be interacting with them, if they are providing medical care for you, you want to make sure these are people that you're comfortable with, that you trust, and that you know are going to be working for you and the level of care. You know some people have a medical history where they just automatically need a higher level of care and so that can definitely influence where you're going to get care. Are there myths around birth control, affecting fertility reproduction? And is it really necessary to plan ahead when selecting birth control? So this is more a medical thing, I am not a medical person in that, like, I am a coordinator. I'm not an MD or a nurse practitioner, or anything like that, but I did talk to the team about this. There is no data to say that birth control decreases or influences fertility and I think anytime you're selecting birth control it's important to talk to your provider about that choice, and they can give you plenty of information about the different options. And the last question that we had submitted was: what are some common misconceptions about fertility or infertility with cis gender men? Originally, when the conversations about infertility first started it was always the persons with the uterus-- you know it was always something on their end. And even today that still happens, so it's important to just remember all sides of the equation. And it could be the eggs, it could be the sperm, it could be a number of things, there are so many things that that influence our body and influence trying to get pregnant. I don't know what it was about December, but, like everyone was ovulating later than they expected, everyone's like I am bleed...I was like you are not alone. Who is late this month? I don't know if they're stressed out about the holidays or what but it's amazing what stress can do to the body. So... I will give Julian my my email, and my phone number, so if anyone has questions or is looking for resources, I always encourage people to reach out, we have a number of resources, even for people who aren't the right fit for our Program. But yeah it's a really great program; I'm so proud to be a part of it, you know, helping people get pregnant is stressful but exciting; and you get a lot of fun baby pictures send to you this is always nice and yeah I look forward to a future where these kinds of things are automatically covered. Like, can you imagine insurance covering buying sperm one day? One day we'll get there! And I know there's some some great people are Massachusetts government who are working to get some very important bills push through. Yeah and so that's that's what I got, thank you.
Julie Le: Actually I have another question. I think perhaps this one is for Elly. It is: are there any common roadblocks queer families face when applying to foster and can foster parents choose to foster only queer or trans kids?
Elly: Good question. In general, I would say that the foster care system as a whole lot better... You.. about being open to working with. Your family yes. um. I have done some work with the foster care system and more and more on the foster care system leads in Massachusetts is starting to see queer families as an asset, and the first and something that they would like more of. In particular, when it comes to wanting to only foster queer kids or teenagers absolutely you can have full control over sort of what boundaries you put around what kind of children you'd like to accept in your home, so when you are doing that initial foster care application. You can say I am only interested in, you know teenagers 15 and up and I'm only interested in teens with queer identities and they can absolutely do that for you. I know that we actually have...oh gosh... who sometimes puts on a number of good, clear local events actually has hosted a number of kind of introduction, fostering. for parents who are interested in fostering queer kids. I'm not sure if he's still running those now but um there's a lot of really good information out there, you can definitely focus on just your kids if you want to you, and something that is very, very much needed; look more into it.
Julian Cancino: Not sure if everybody got the same speed, sped up entirely, as I did, which was like really interesting. So Elly, we have you back now; one of the other questions that came to my mind, had to do with sort of you can talk a little bit about the process of choosing what your children could call you? You know, say this and dad is... and mom is something else, and perhaps share some of the different terms. People have been thrown around in the support group, and you know sort of like in this family forming ,you know, non-hetero normative there are many other endearing terms that people choose for themselves and perhaps you can share some of those?
Elly: Sure absolutely I actually meant to mention that, that can be so huge, especially for our non-binary parents or folks who are gender non-conforming or even families where you maybe have two parents have the same gender identity and you don't want to both be mom or both be dad because that's confusing. And I guess that what I see is that there is no necessarily direct straightforward approach that every single person takes. We've had a lot of good conversations about that in our support group and some of my favorite as kind of solutions or ways that people have address that has been taking terms that come from a particular cultural backgrounds, that they have so I know that people have there are a lot of different terms. For example, that people may use to refer to grandparents but that can be kind of co-opted into parental type names so we've had like talks about Baba and gigi and gosh I wish I could remember all of them, but there were so so many good ones. I know that one of our non-binary folks in the group recently decided that what they would really be excited about is to be called papi. That comes from their own particular cultural background and there are a number of other ones that you know there's a wealth out there, I don't know if it would be best to refer to your own family history. If there are terms of endearment that have been used for family members there, if there's something cultural that you want to sort of delve into, or if you want to create your own word. It really is up to you and there is no really writer way right or wrong way to go about it. It's just sort of another aspects to you know building your own family and choosing your own adventure whatever feels most comfortable to you.
Salem Quinn: I wanted to jump in also. Not only do I work for the alternative insemination program I'm also a patient and my partner and I welcomed our son into the world last summer. And it was through pregnancy and childbirth, that I realized my gender identity as a non-binary person and the word mom did not feel right for me; and so I was so fortunate that I was in a queer early parenting support group, where one week we talked about gender and parenting and people had thrown out a lot of different ideas, and I did some searching on my own and I'm Jewish and I was like I'm going to go with E-MA, which is the Hebrew word for mom and and I know that is a bit more femme. But for the common person that I tell that to, they they don't know what E-ma is, and so it feels like a very gender neutral word for me to use and yeah it's been very interesting kind of choosing my own adventure to define the word that that feels right for me.
Julian Cancino: Giving my seven second rule of silence.
Julie Le: Do we have time for more questions?
Julian Cancino: We do, yes.
Julie Le: And we just want to remind you all to that if you'd like to send me questions through the chat, that's possible. There's also a link there to send them anonymously, so please take the time to do so if you have any last minute questions.
Julian Cancino: So well folks, I think you know I'll throw one out there, we have like five minutes, so that folks know. I'm a planner and I'm assuming some folks here are planners this process is very intentional. So I'm assuming before people who know their orientation or they go to their you know insurance or health care provider, what are some good resources, websites, books that people can read up to know more or less what kind of questions to ask, but to consider before that big component?
Salem Quinn: The first one that comes to mind is family equality. They are just such a great resource and they have all kinds of articles blog posts and then links to kind of specific local resources as well. P flag is always good for for resources and I have a number of books that I think rather than kind of go through them all here, I can I can send that list to Julian to make it available and yeah there are. I mean even now it's... I'm finding, there are a lot of like queer parenting like Facebook groups where people share resources and experiences and that can be so helpful for people as they're navigating this process of becoming parents and yeah. But yes, I can definitely provide a list of resources that can be helpful for people who are trying to get this process figured out.
Julian Cancino: I think that's it. Thank you so so much, as always, you know you can reach out to me at juliancancino@brandeis.edu happy to re-share the resources that both Salem Ally sends (accident) That Salem and Elly share with us. And I'm just so thankful for the work that you do not only for our Boston and New England Community but also Amsterdam, so thank you so much. And I am so, so grateful for all of you who joined in a part of this moment with us, but also both of you-- Elly and Salem. Thank you so much for your time. Till next time, thanks for having us.
Salem Quinn: Thank you.